Objectives: (1) To delineate the differences between lean and obese
polycystic ovary syndrome (PCOS). (2) To review different modalities for
management of infertility associated with PCOS. Mechanism: Literature
review of PubMed from 2000 to 2023. Findings in Brief: Body weight is
more important than the Rotterdam phenotype in influencing the metabolic status.
Both the lean and obese PCOS groups exhibit individual differences in body
composition and other parameters: clinical signs, psychological, hormonal,
metabolic, and genetic profiles. Lean PCOS differs from lean non-PCOS regarding
metabolic profile, hepatic impairment, and cardiovascular risks. Management:
lifestyle modifications serve as first-line therapy, emphasizing weight
maintenance with a high caloric intake during breakfast and reduced intake at
dinner. Additionally, micronutrients supplementation and resistance exercise are
recommended. Induction of ovulation through the administration of as adjunctive
therapies letrozole, clomiphene citrate, and metformin may be considered.
Laparoscopic ovarian drilling (LOD) may be considered in cases where medical
induction of ovulation failed. Intrauterine insemination is associated with
promising results. Assisted reproductive techniques (ART) are recommended for
women who fail to conceive despite the restoration of ovulation, or when
additional factors contribute to their infertility. Conclusions: A
significant proportion of patients with PCOS exhibit normal body mass index
(BMI). The management of PCOS-associated infertility should be individualized
based on the patient’s BMI.